Paraneoplastic Cushing's syndrome in prostate cancer: a difficult management problem

Cushing's syndrome associated with small-cell de-differentiation of prostate cancer is rare, but well described. The detection of Cushing's syndrome in a patient with prostate cancer can be problematical, and when occurring in prostate cancer nearly always implies the development of small-cell transformation. Testosterone levels in these patients are likely to be in the normal range, despite previous castration. The features of Cushing's syndrome contribute considerably to patients' morbidity and probably to their mortality. The syndrome is unlikely to be controlled with inhibitors of steroid synthesis, and chemotherapy is likely to be poorly tolerated, resolving the syndrome in only a few patients. We suggest that bilateral adrenalectomy at an early stage should be considered, possibly as a preliminary to anticancer treatments.